passive movements in itu

[Martin345]

i've just started at a new hospital
the previous itu senior physio said they don't do passive movements on itu patients as there is no evidence that doing these once per day has sufficient carryover to the next day to make them worthwhile. if ROM is decreasing then splints should be used.

what do you think? i'm all in favour of splints if things are deteriorating, but i've always been a fan of passive movements for a variety of reasons.

is there any evidence or research into this that has been related to itu? i will ask our expert musculoskeletal colleagues as well.

Similar Threads:

• Q. re. passive stretching.
• Passive movements v active movements
• Passive Movements
• passive movements in itu - worthy?
• passive movements in general

[shane246]

Now here is a question that is begging to be answered - do PM make a difference in ICU, and if so what 'dosage' is required to be effective?
I am not aware of any ICU specific trials evaluating PM and did at one stage consider setting up a trial. My gut feeling is that PM are useful as an assessment tool, but I struggle to think that PM performed over a couple of minutes (max) per day are sufficient threshold for change/maintenance of PROM, when joint may be stagnant in mid range (or other!) for the bulk of the 24hr period.
On the issue of splints, I think they are a useful adjunct, but tend to find they lead often to more problems that they are worth - incorrect construction or application leading to ineffectiveness in position maintainence, pressure areas, or simply not being applied ('forgotten' or tidied away by nurses).
Why is it that such a widely utilised technique (an assumption in itself) is continued in this evidence-based era in the abscence of research either way? Too hard? Not glamorous? Other priorities?

[Fiona Schreuder]

I agree with all your comments. My junior carried out an audit a couple of years ago in Wales and south England to ascertain the use and pattern of use of PMs in the ITU setting. People certainly do use them in varying degrees. I personally prefer to use positioning to maintain joint ROM and splint (usually Feet/ ankles) when ROM starts to decrease. I think it would be relatively easy to set up a multi- centre RCT looking at the effects of PMs. I am working in the academic setting now and don't have access to patients but would be happy to be involved in the planning process for such a trial. Are other people interested in getting something going?

[fijolek uni]

I don't understand what is all about. If U know the meaning and importance of PMs You've got an answer. I'm using PMs and PNF patterns at Cardio ICU. Our patients sometimes "stay" for a couple of months with us. Coma, stroke, long-term gone and other complications.
We treat them twice a day for at least 30 min. We use also positionig with change after 2h, but that is nursing stuff duty. We don't use splints 'couse it carries to much risk
We prefer to prevent not to get tired later... (and our bedsores prevention is working very good)

I personally prefer to use positioning to maintain joint ROM and splint (usually Feet/ ankles) when ROM starts to decrease

but why it starts to decrease? maybe because of lack of PMs ??
I know that there can appear periarticular calcifications, but if we work hard, decreasing ROM can be slower...

[gpywwp]

need at least 3 3-hour sessions per day using continuous passive movement machine to achieve preservation of muscle fibre architecture in icu patients receiving muscle relaxant. if i have to do it myself, i'll be critically ill with exhaustion!:\

Griffiths RD, Palmer TE, Helliwell T, MacLennan P, MacMillan RR. Effect of passive stretching on the wasting of muscle in the critically ill. Nutrition. 1995 Sep-Oct;11(5):428-32.

[davidlinehan]

I am currently trying to establish current best practice in relation to passive movements in ITU as there is insufficient literature in this area. If anyone has any audit that they could forward to me it would be a great help.